Approval Officer - Insurance Claims

About the role

NMC Healthcare is hiring an Approval Officer in Dubai. The role reviews and verifies pre-authorization requests (OP/IP) from hospital departments so that insurance patients can obtain authorizations from their insurers, in line with plan coverage and regulatory standards such as claim adjudication rules.

Key responsibilities

• Evaluate pre-approval requests for medical necessity and code services according to accepted medical coding rules and the policy schedule of benefits.
• Handle rejected pre-authorizations: obtain justification from the treating doctor and resubmit them to the insurer.
• Respond promptly to insurer/TPA queries and liaise with the relevant departments.
• Receive, evaluate and escalate second-opinion cases and case management matters.
• Prepare daily activity reports and assist management with monthly reporting.
• Attend meetings and presentations, and cover colleagues' sudden or unplanned leave.
• Manage and hand over pending cases to the next shift.

Required profile

• Bachelor's degree in medicine or an equivalent medical degree from a recognized university.
• Minimum 2 years of experience in insurance claims management or adjudication.
• Excellent command of written and spoken English.
• Able to work under pressure and in shifts.

Required skills

• Knowledge of medical coding systems: ICD, CPT, DRG and HCPCS.
• Proficiency in Microsoft Office applications.